PACS:
1. n. (acronym)Picture Archiving and Communications System. A device or group of devices and associated network components designed to store and retrieve medical images.
2. n. (acronym)Pain And Constant Suffering.

Tuesday, February 28, 2012

Great ExSPECTations

I'm on my way back home from frigid Ann Arbor, having just spent the morning in an amazing Nuclear Medicine department. It's embarrassing, really. Our entire Radiology and Nuc Med divisions would have fit easily within the confines of the U of Michigan Nuclear Cardiology Department alone! I lost count of the number of scanners I saw, and we never even ventured into non-Nuclear territory. Maybe there is something to this academic stuff after all.

I am very grateful to the folks whose schedules we disrupted, in particular Jeff M., and Dr. B., who gave very generously of their time to show us the Siemens Symbia SPECT/CT scanners (several of them...LOTS of them!), discuss their operation and go over images and protocols.

The Symbia series has been around for a few years, which means two things: the bugs have been worked out of the platform, and it may not be at the bleeding edge of technology. At this point in my career, a proven track record tends to trump all else. The CT component is a little long in the tooth, basically the older Emotion platform, but its images are fine. Really, the only thing it really lacks for my purposes is the ability to utilize iterative reconstruction. This could perhaps be added in software, but apparently that is not a likely event. I'm still satisfied with the dose in the setting of a SPECT/CT acquisition.

Symbia does offer IQ-SPECT for cardiac studies, which will allow either a reduction of injected tracer dose, or a significant time-savings. How about acquiring a cardiac scan in 4 minutes instead of 20? Or double the counts with a 6-minute study? Or cut the dose back with a longer scan? I'll let you read the brochure for yourself, but in viewing live studies, I can tell you that the IQ-SPECT scans look about the same as those from the conventional protocol. Key to the process is a focused collimator, the successor if you will of Siemens' old CardioFocal collimators we used to have on our Orbiters from 1990. Everything old is new again, as they say...

The physician (a cardiologist, actually) who had done much of the research for IQ-SPECT was not available today, but I did have a great conversation with Dr. B, a private-practice rad who had returned to academia, and two of the residents. It seems they were not familiar with me and the blog, but I gave them my card, containing my URL. Hope you guys aren't too disappointed in what you find here!

Dr. B and I commiserated on the joys and perils of Private Practice Radiology, not the least of which is having decisions about equipment often made by administrators and vendors, and having no recourse for bad equipment. I sheepishly mentioned that I have on rare occasions used this blog to hold a vendor accountable (I believe I might have said something like "hold their feet to the fire" but that wouldn't be like me) for bad products. He nodded approvingly, and said, "I think you would fit right in with Academic Medicine." Which I take as an incredible complement.

The two residents were quite impressive themselves, and I wish we were hiring so I could rescue them from the horrendous weather up there in Michigan.

Due to various machinations, we won't be looking at the Discovery 670 NM/CT 670 this time around. However, I will say this now: we will never again buy a conventional gamma camera without integrated CT. (I can act like a big-shot with other people's money, but it makes perfect sense.) I do believe we are to have a peek at the Philips Precedence before the final decision is made. I hope we have a room big enough for it!

6 comments
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...wow, I remember tooling on the precursor to the Symbia system in a "Secret" room in Knoxville, years past. Come to think of it, we had one in Haifa when I trained there that was the blueprint for the line of devices you see today. A dollar goes to the one who can determine my nom-de-plume;-)